Factors associated with perceived stress in Middle Eastern university students

Figures & data

Table 1. Distribution of the Perceived Stress Scale (PSS-4) by main student demographic characteristics.

Students’ characteristics	Participants N (%)	PSS-4 (0-7)	PSS-4 (8-16)	Odds Ratio (95% CI)	P-value
ALL	370 (100)	190	172
Age
18 years old	110 (29.7)	59	50	1.00
19 years old	83 (22.4)	35	47	1.59 (0.89–2.82)	0.12
20 years old	75 (20.3)	40	32	0.94 (0.52–1.72)	0.85
21–24 years old	76 (20.5)	41	33	0.95 (0.53–1.72)	0.86
≥25 years old	23 ( 6.2)	15	7	0.55 (0.21–1.46)	0.22
Sex
Male	141 (38.1)	90	50	1.00
Female	228 (61.6)	99	122	2.24 (1.45–3.47)	0.0003
Country of origin
Qatar	163 (44.1)	91	68	1.00
Other EMR country, Asia, Africa	147 (39.7)	65	80	1.65 (1.05–2.59)	0.03
Europe, America, Oceania	42 (11.4)	26	15	0.77 (0.38–1.57)	0.47
Field of study at University
Fine arts	48 (13.0)	23	23	1.16 (0.66–2.02)^†	0.61
Medicine	41 (11.1)	20	20	1.16 (0.64–2.09)^†	0.63
Engineering	87 (23.5)	45	39	1.00 (0.64–1.56)^†	0.99
Business / computer studies	80 (21.6)	43	37	0.99 (0.63–1.57)^†	0.98
Foreign service	38 (10.3)	20	18	1.04 (0.57–1.90)^†	0.90
Journalism	31 ( 8.4)	13	18	1.60 (0.82–3.11)^†	0.17
Archeology	14 ( 3.8)	9	4	0.51 (0.18–1.47)^†	0.21
Academic Bridge Program	31 ( 8.4)	17	13	0.88 (0.45–1.73)^†	0.72
Education program
Pre-university	31 ( 8.4)	17	13	0.87 (0.39–1.95)	0.74
Undergraduate, first year	125 (33.8)	65	57	1.00
Undergraduate, sophomore	88 (23.8)	34	53	1.78 (1.02–3.11)	0.04
Undergraduate, junior	62 (16.8)	35	25	0.82 (0.44–1.52)	0.52
Undergraduate, senior	36 ( 9.7)	21	15	0.82 (0.38–1.73)	0.59
Post-graduate	27 ( 7.3)	17	9	0.60 (0.25–1.46)	0.26
Place of residence
On-campus	93 (25.1)	58	34	1.00
Off campus	277 (74.9)	132	138	1.78 (1.10–2.90)	0.02

* PSS score is missing for eight participants; age for three; sex for one; nationality for 18; education program for 1.

^† Odds Ratio calculated using the population average as reference category.

Other countries from the WHO Eastern Mediterranean region (EMR) include: Afghanistan (n = 1); Bahrain (n = 2); Egypt (n = 25); Islamic Republic of Iran (n = 1), Iraq (n = 1), Jordan (n = 15), Kuwait (n = 2), Lebanon (n = 7), Morocco (n = 1), Occupied Palestinian territory (n = 5), Oman (n = 1), Pakistan (n = 32), Saudi Arabia (n = 3), Sudan (n = 9), Syrian Arab Republic (n = 2), Tunisia (n = 3), Yemen (n = 1).

Figure 1. Distribution of the 4-point perceived stress scale.

Figure 2. Distribution of the 4-point perceived stress score by sex, quality of sleep and satisfaction with life.

Table 2. Factors associated with elevated perceived stress at univariate analysis.

Factor	Participants N (%)	PSS-4 (0–7)	PSS-4 (8–16)	Odds Ratio (95% CI)	p-value
DIET
Low fresh fruit juice intake (below median)	176 (47.6)	81	93	1.57 (1.03–2.38)	.04
High soft drinks intake (above median)	459 (49.0)	74	85	1.55 (1.02–2.35)	.04
Feeling about healthy food statements
It is not important for me to eat healthy^†	69 (18.6)	28	39	1.70 (0.99–2.90)	.05
I am too busy to eat healthy foods^†	181 (48.9)	80	97	1.84 (1.21–2.79)	.005
Eating habits frequency
Eat dinner (below median)	134 (36.2)	58	73	1.67 (1.08–2.58)	.02
Eat when bored (above median)	148 (40.0)	61	86	2.07 (1.35–3.17)	.0009
Eat when stressed (above median)	217 (58.7)	97	114	1.85 (1.20–2.84)	.005
Eat when angry (above median)	105 (28.4)	40	63	2.14 (1.34–3.41)	.001
PHYSICAL ACTIVITY
Sitting during weekday (above median)	122 (33.0)	54	66	1.80 (1.06–3.07)	.03
Barriers for not exercising regularly
Lack of self-discipline	115 (31.1)	48	64	1.73 (1.10–2.71)	.02
Self-conscious/sociocultural norms	20 ( 5.4)	4	15	4.40 (1.43–13.5)	.01
Environmental conditions	37 (10.0)	11	24	2.61 (1.24–5.50)	.01
Lack of an exercise buddy	74 (20.0)	30	43	1.76 (1.04–2.96)	.03
SLEEPING
Fall asleep after 20 min	144 (38.9)	59	81	1.96 (1.27–3.02)	.002
No more than 6 hours of actual sleep	180 (48.6)	82	96	1.62 (1.07–2.46)	.02
Bad overall quality of sleep^‡	127 (34.3)	44	83	2.99 (1.90–4.70)	<.0001
Reasons for trouble sleeping
Cannot sleep within 30 min	119 (32.2)	45	70	2.18 (1.38–3.43)	.0008
Wake up in middle of night or early morning	154 (41.6)	67	86	1.80 (1.18–2.76)	.007
Have bad dreams	71 (19.2)	27	43	1.98 (1.16–3.38)	.01
Have pain	61 (16.5)	21	38	2.25 (1.26–4.02)	.006
SCHOOLING
Trouble concentrating during class	216 (58.4)	88	126	3.08 (1.98–4.80)	<.0001
Trouble staying awake during class	174 (47.0)	78	93	1.62 (1.06–2.45)	.02
OVERALL SATISFACTION WITH LIFE
Good	151 (40.8)	105	42	1.00
Average	81 (21.9)	41	38	2.32 (1.31–4.09)	.0004
Poor	111 (30.0)	28	81	7.23 (4.14–12.7)	<.0001

^† Agree or strongly agree vs neutral, disagree or strongly disagree.

^‡ Very bad or fairly bad vs fairly good or very good.

Table 3. Factors associated with elevated perceived stress at multivariable analysis.

Factor	Strata	OR (95% CI)	p-value
Sex	Female vs male	1.84 (1.07–3.17)	.03
Country of origin	Other EMR country, Asia or Africa vs Qatar	2.60 (1.40–4.80)	.002
	Europe, America, Oceania vs Qatar	0.81 (0.32–2.00)	.64
Place of residence	Off-campus vs on-campus	2.13 (1.09–4.18)	.03
Eat when bored	Above median vs below median	2.12 (1.27–3.55)	.004
Do not exercise for lack of self–discipline	Yes vs no	1.93 (1.11–3.36)	.02
Trouble sleeping because	Cannot sleep within 30 min vs sleep	2.21 (1.28–3.81)	.005
Trouble concentrating during class	Yes vs no	2.32 (1.38–3.92)	.002
Overall satisfaction with life	Average vs good	1.87 (0.99–3.51)	.05
	Poor vs good	6.35 (3.37–12.0)	<.0001

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to ethical restrictions; they contain information that could compromise the privacy of research participants.